Benefit of thrombolysis for stroke is maintained around the clock: results from the <scp>SITS</scp>‐<scp>EAST</scp> Registry

Kõrv, Janika; Vibo, Riina; Kadlecová, Pavla; Kobayashi, Adam; Członkowska, Anna; Brozman, M; Švigelj, Viktor; Csiba, László; Fekete, Klára; Demarin, Vida; Vilionskis, Aleksandras; Jatužis, Dalius; Krespi, Yakup; Ahmed, Niaz; Mikulík, Robert

doi:10.1111/ene.12257

Cited by 12 publications

(9 citation statements)

References 22 publications

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“…The majority of IS occurred over the daytime hours with a strong peak in the morning hours 6:01 h to 9:00 h, as was previously observed (14, 18–20). The proportion of patients admitted within the 4.5-h time window was observed to be lowest when IS occurred during nighttime hours 0:00 h to 6:00 h and highest during daytime and early evening hours 6:01 h to 21:00 h and thus confirms a direct relationship with the sleep–wake cycle (20). Hospital admission rates increased remarkably between 9:01 h and 12:00 h with the wake-up stroke patients from the night being additionally admitted and then showed a constant decline over course of the day.…”

Section: Discussionsupporting

confidence: 82%

Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

et al. 2017

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IntroductionBased on data from the Baden-Wuerttemberg stroke registry, we aimed to explore the diurnal variation of acute ischemic stroke (IS) care delivery.Materials and methods92,530 IS patients were included, of whom 37,471 (40%) presented within an onset-to-door time ≤4.5 h. Daytime was stratified in 3-h time intervals and working vs. non-working hours. Stroke onset and hospital admission time, rate of door-to-neurological examination time ≤30 min, onset-/door-to-imaging time IV thrombolysis (IVT) rates, and onset-/door-to-needle time were determined. Multivariable regression models were used stratified by stroke onset and hospital admission time to assess the relationship between IVT rates, quality performance parameters, and daytime. The time interval 0:00 h to 3:00 h and working hours, respectively, were taken as reference.ResultsThe IVT rate of the whole study population was strongly associated with the sleep–wake cycle. In patients presenting within the 4.5-h time window and potentially eligible for IVT stratification by hospital admission time identified two time intervals with lower IVT rates. First, between 3:01 h and 6:00 h (IVT rate 18%) and likely attributed to in-hospital delays with the lowest diurnal rate of door-to-neurological examination time ≤30 min and the longest door-to-needle time Second, between 6:01 h and 15:00 h (IVT rate 23–25%) compared to the late afternoon and evening hours (IVT rate 27–29%) due to a longer onset-to-imaging time and door-to-imaging time. No evidence for a compromised stroke service during non-working hours was observed.ConclusionThe analysis provides evidence that acute IS care is subject to diurnal variation which may affect stroke outcome. An optimization of IS care aiming at constantly high IVT rates over the course of the day therefore appears desirable.

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Section: Discussionsupporting

confidence: 82%

Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

et al. 2017

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“…25 Interestingly, however, no relationship between circadian stroke occurrence and effectiveness of thrombolytic therapy has been in a recent observation from a large stroke registry. 26 Conflicting results on the seasonal variation in the occurrence of stroke have been reported in populationbased studies. In some of these studies there was a peak in incidence in the winter or the winter and spring, 8,27,28 whereas in some of the studies done in subtropical countries, admissions to hospital with an ischemic stroke were more common on hot days, and peak in stroke mortality occurred during heat waves.…”

Section: Discussionmentioning

confidence: 99%

Seasonal Differences and Circadian Variation in Stroke Occurrence and Stroke Subtypes

Raj

Bhatia

Prasad

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Several studies have described the so-called 'weekend phenomenon' [5][6][7][8][9][10][11][12]. Some authors also suggest that patients admitted during out-of-office hours [13,14] or night hours [7,15,16] may achieve less favorable outcome. However, the amount of evidence is still not sufficient, especially regarding treatment with rtPA.…”

Section: Introductionmentioning

confidence: 99%

Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers

Karliñski

Kobayashi

Sobolewski

et al. 2014

Neurologia i Neurochirurgia Polska

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Benefit of thrombolysis for stroke is maintained around the clock: results from the SITS‐EAST Registry

Abstract: The time when stroke occurs (day versus evening versus night) does not affect the outcome after thrombolysis despite the fact that patients with night-time strokes have worse time management.

Cited by 12 publications

References 22 publications

Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

Diurnal Variation of Intravenous Thrombolysis Rates for Acute Ischemic Stroke and Associated Quality Performance Parameters

Seasonal Differences and Circadian Variation in Stroke Occurrence and Stroke Subtypes

Is there a bad time for intravenous thrombolysis? The experience of Polish stroke centers

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